Abstract
Cervical pregnancy (CP) is a rare form of ectopic pregnancy (< 1%) located on the lining of the endocervical canal with frequency at about 1 in 1 000 to 1 in 18 000 deliveries. Cervical gestation is extremely rare beyond 20 weeks and there are few reports in the literature of vaginal live birth with a high mortality risk. Awareness and early diagnosis is essential due to the possibility of a life-threatening hemorrhage, treated with hysterectomy in the past. Cervical ectopic pregnancy can be mistaken on ultrasound examination with similar pathologies and due to the differences in the management and the outcome an accurate diagnosis is of a great importance. Authors describe two cases of ectopic pregnancies in the isthmico-cervical region successfully terminated with a nonsurgical approach.
Highlights
Low-lying ectopic implantation in the uterus can occur in the cervix, the isthmico-cervical region and in the area of a previous Cesarean scar
Cervical ectopic pregnancy can be mistaken on ultrasound examination with similar pathologies like low implantation of normal uterine pregnancy, incomplete abortion, cesarean scar pregnancy, cervical mass, nabothian cyst, hetero topic pregnancy
Cervical ectopic is a challenging to manage with a high rate of incorrect diagnosis as a cervical miscarriage. It is the rarest type of ectopic pregnancy with life-threatening risk of severe hemorrhage
Summary
Low-lying ectopic implantation in the uterus can occur in the cervix, the isthmico-cervical region and in the area of a previous Cesarean scar. Treatment of cervical ectopic pregnancies in the past included surgical intervention and hysterectomy was considered as a first option This leads to loss of reproductive functions and is associated with significant morbidity and potential mortality. Ultrasound examination revealed a low-lying gestational sac on the area of the Cesarean scar with a picture of thicker myometrium between the sac and the bladder (Figure 2a). Due to lack of genital bleeding and no abdominal cramping the patient was attended for reevaluation after few days if a differential diagnosis of cesarean pregnancy, incomplete abortion or isthmico-cervical pregnancy can be obtained. Figure 2a: Low - implanted 6 weeks and 6 days pregnancy with empty gestational sac
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